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COPD

Treatment

Medications for COPD

This page explains the main medicines used to treat COPD and how they can help your symptoms.

COPD medicines cannot cure COPD, but they can improve your symptoms. By taking the right medicine at the right time, you can:

  • be more active
  • have less coughing and shortness of breath
  • get fewer flare-ups

Your doctor will prescribe the COPD medicines that are right for you. Make sure you know:

  • which medicines you are taking
  • how to take them
  • when to take them
  • who to ask if you have any questions

Different kinds of COPD medicine do different things for you:

Medicines to treat shortness of breath: bronchodilators

If you have COPD, your main symptom is probably shortness of breath. You might get short of breath when you exercise, when you do chores, when you feel upset, or for no reason at all.

Bronchodilator medicines open up the airways (breathing tubes) in your lungs. When your airways are more open, itís easier to breathe. Doctors may prescribe more than one kind of bronchodilator to treat COPD.

There are two main types of bronchodilators that come in inhalers:

  • Beta-2 agonists, for example:
    • salbutamol (Ventolin ®)
    • terbutaline (Bricanyl ®)
    • formoterol (Oxeze ®)
    • salmeterol (Serevent ®)

    Some side effects: fast heartbeat, irregular heartbeat, irritability (feeling cranky), difficulty sleeping, muscle cramps, and shaky hands. More serious side effects are rare. Side effects are usually less noticeable as time goes on.

  • Anticholinergics, for example:
    • ipratropium bromide (Atrovent ®)
    • tiotropium (Spiriva ®)

    Some side effects: occasional dry mouth. Men who have trouble with their prostate gland may have difficulty urinating (peeing).

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Some bronchodilators work quickly, others work slowly

Rapid-onset bronchodilators (also called quick-relief medicines) act quickly and start to relieve shortness of breath within minutes. They are often used as needed, to help relieve sudden shortness of breath. Quick-relief medicines usually come in a blue puffer.

Some rescue medicines are short-acting and last for 4-6 hours (like Ventolin ® or Bricanyl ®). Some are long-acting and last for up to 12 hours (like Oxeze ®).

Slow-onset bronchodilators take longer to act. Some last for 4 to 6 hours (like Atrovent ®), and some last up to 12 hours (like Serevent ®). One slow-onset bronchodilator lasts for 24 hours (Spiriva ®).

If you're short of breath and need help right away, take a quick-relief medicine like Ventolin ®, Bricanyl ®, or Oxeze ®. Quick-relief medicines usually come in a blue puffer. Keep your quick-relief medicine with you at all times, so itís there when you need it.

All the bronchodilators listed above come in puffers (inhalers). Learn how to use puffers (inhalers) and other devices.

Thereís another kind of bronchodilator that opens your airways. This one is in pill form:

Xanthines or theophyllines (such as Uniphyl® or Theodur ®)

Xanthines or theophyllines are slow-onset bronchodilator pills. They donít open your airways as well as inhaled bronchodilators, and they can have serious side effects and drug interactions. For these reasons, xanthines/ theophyllines are not commonly used. When they are used, itís usually in combination with other bronchodilators.

Some side effects: nausea, heartburn, restlessness and fast heartbeat.

Xanthines/theophyllines can interact with food and other medicines. Make sure your doctor and pharmacist knows all the other medicines you are taking. If you are taking these pills, your doctor will give you regular blood tests to monitor how much of the medicine is in your body.

Medicines to prevent and treat COPD flare-ups

A COPD flare-up is when your symptoms get worse. Some symptoms of a COPD flare-up are more shortness of breath, more coughing, and more phlegm (mucus). Itís very important to prevent flare-ups and to treat them as soon as you can. Flare-ups are the main reason COPD patients go to hospital. They can be deadly.

Combination medicines: inhalers that combine a bronchodilator and a corticosteroid

If you have ongoing breathing problems and moderate or severe COPD, your doctor may prescribe a combination medicine. They combine a bronchodilator that relieves shortness of breath, and an inhaled corticosteroid that brings down the swelling in your airways. Over time, combination medicines can help prevent COPD flare-ups.

Keep in mind that corticosteroids for COPD are not the same thing as the anabolic steroids some bodybuilders take to build muscle.

Some combination medicines for COPD are:

  • Advair ® (Flovent ® combined with Serevent ®)
  • Symbicort ® (Pulmicort ® combined with Oxeze ®)

Combination medicines are ďpreventerĒ medicines that need to be taken every day, usually twice a day. They help over time, but they do not help right away. If you need help right away, take a quick-relief medicine like Ventolin ®, Bricanyl ®, or Oxeze ®.

Some side effects: shaky hands (tremor), fast heartbeat, thrush (a whitish film covering your throat and tongue), a sore throat or a hoarse voice. You can have fewer Some side effects if you:

  • take the medicine as directed by your doctor
  • rinse your mouth with water after each dose: rinse, gargle, and spit the water out.
  • use a spacing chamber with your puffer
Corticosteroid pills

Corticosteroids also come as pills, (for example, Prednisone ®). Corticosteroid pills have more side effects than the inhaled corticosteroids that are in combination medicines. Corticosteroid pills are used for short periods of time, usually when you have a moderate or severe COPD flare-up. They should not be taken on a regular basis unless your doctor says so.

Some side effects: thinning and bruising of the skin, sore throat, hoarse voice, bloating, weight gain, emotional changes, problems with blood sugar control, problems with blood pressure control. You can talk with your doctor or pharmacist about these Some side effects.

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Medicines to treat infections: antibiotics

COPD flare-ups can be caused by viral infections (for example, the flu) or bacterial infections (for example, bacterial pneumonia). If you have a bacterial infection, you can treat it with antibiotics. If you have a viral infection, antibiotics won't work.

Your doctor may give you an antibiotic prescription to have at the ready, and tell you to fill the prescription if you feel a COPD flare-up coming on. Your doctor will give you a COPD action plan with clear directions on what to do and what medicine to take if you have a flare-up. Be sure to ask questions if you are not sure about what your COPD action plan means.

Itís important to take your antibiotics as directed by your doctor and to take all of the antibiotics. When people donít take all of their antibiotics, infections can become stronger and harder to treat.

Medicine to prevent flare-ups: flu and pneumonia shots

Shot (vaccines) can help protect you against some strains of flu and pneumonia. Flu and pneumonia shots can lower your chances of getting a flare-up and needing hospital care.

Medicine to boost your oxygen level: supplemental oxygen

If you have more severe COPD, it may be hard for you to get enough oxygen from the natural air. Low oxygen levels can make you more short of breath and tired. If your blood oxygen level is very low, the doctor may prescribe supplemental oxygen. Studies show that when people who need supplemental oxygen get it, they can live longer.

People who take supplemental oxygen must continue taking their other medications.

Not everyone who has COPD needs to be on oxygen. To find out if you need supplemental oxygen, speak to your doctor or certified respiratory educator.

Generally, oxygen therapy can help people with:

  • very low blood-oxygen levels (hypoxemia)
  • temporary lung damage from infections (for example, pneumonia)

Oxygen only helps people who have very low blood-oxygen levels. Ask your doctor to test to see if oxygen might help you.

Benefits of oxygen

If your doctor says oxygen is right for you, you can enjoy these benefits:

  • it lengthens life by preventing heart strain from low levels of oxygen
  • it improves the way you feel and think
  • it decreases shortness of breath
  • it helps you exercise more easily
  • it cuts down on your need to go to the hospital

How does oxygen therapy work? Oxygen therapy is generally delivered as a gas from a cylinder or concentrator. You breathe in the oxygen through small nasal "prongs" that fit into your nostrils, or through a mask that covers your mouth and nose. Breathing in this extra oxygen raises low blood-oxygen levels, easing the strain on your body and making breathing easier.

Because your body can't store oxygen, the therapy works only while you use it. If you take off your oxygen mask or remove the prongs, your blood-oxygen level will drop within a few minutes.

Like any other prescription medicine, oxygen must be used carefully. You need to follow instructions and follow all the safety precautions. Your doctor will tailor your oxygen prescription to your individual needs. Be sure you get instruction on how to use your oxygen, and how to clean your equipment.

How long do people use oxygen therapy? You may be on oxygen therapy for a few weeks or months, or for the rest of your life. It depends on why you need it. If you have a lung infection, you may need to be on oxygen only until the infection clears and your blood-oxygen levels return to normal. If you always have low blood-oxygen levels, you may need to be on oxygen permanently.

More information about oxygen

You can't use oxygen if you smoke. No one can smoke within 10 feet (3 meters) of oxygen tanks, because of the risk of fire. You can't use oxygen anywhere near an open flame (candle, fireplace, etc).

Ask how to use the equipment. Learning how to use and care for the oxygen equipment may seem complicated. Have Ask the oxygen supply company to give you a demonstration. If you're not clear on something, keep asking until you feel confident. For more support, have a family member or caregiver learn about your equipment as well.

Keep your equipment clean. Clean equipment works more effectively. Keeping your equipment clean also helps prevent infections. Always wash your hands before cleaning or handling your oxygen equipment.

Have your doctor check your prescription at least once each year, or if your symptoms change, to see if your oxygen prescription still meets your needs.

Ask about funding. Oxygen therapy can be expensive, especially over the long term. You may qualify for government funding for oxygen therapy - ask your doctor if you're eligible. Funding varies from province to province.

You can travel with oxygen. With some extra help and planning, you can travel by car, plane, boat or train with your oxygen tank. Contact your home oxygen supply company well in advance of your trip to allow them to arrange for oxygen while traveling and at your destination. Learn more about travelling by airplane with oxygen.

To learn more about taking supplemental oxygen, download our fact sheet on oxygen therapy for COPD (PDF). It talks about oxygen tanks, nasal prongs, and other oxygen equipment. It answers common questions about oxygen, and includes tips on using oxygen safely.

How to get the most out of your COPD medicines
  • Write a list of all the medicines you take so that your health care providers can check for possible drug interactions. If you take over-the-counter medicine or natural health products, write those down too. They could interact with your medicines and make your breathing worse.
  • Go to the same pharmacy for all your medicines. If you fill all your prescriptions at the same place, your pharmacy record will show all the medicines youíre taking. This way the pharmacist can make sure youíre not taking any medicines that interact badly together.
  • Make sure you can tell the difference between your inhalers, and make sure you know how to use them properly. You may use several different inhalers for the different medicines you take. You can tell the inhalers apart by their names and colours. Make sure you know which is your quick relief medicine to take when youíre short of breath. Keep it with you at all times.
  • Work with your doctor to decide the best way to treat your COPD symptoms. Talk about your symptoms, activities and concerns. Tell the doctor how you think your medicines are working. Ask questions. Keep asking questions until youíre sure you understand.
  • Speak up if youíre worried about side effects. Like all medicines, COPD medicines may cause side effects. If you have concerns, talk to your doctor, pharmacist or certified respiratory educator. They can help you understand the pros and cons of each treatment.
  • Ask your doctor for a written COPD action plan to help you manage COPD flare-ups. This action plan will explain what to do if you notice your COPD symptoms getting worse. Follow your COPD action plan. To get a blank COPD action plan for your doctor to fill out, click here (PDF).
  • Visit a COPD clinic to learn more about your COPD medicines and how to take them. Ask your doctor about COPD clinics in your area or find COPD clinics in your area by searching in our online directory.
Get complete treatment for your COPD

Medicines are an important way to treat COPD, but there are other treatments too. Learn about all the treatments for COPD.





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